Hand-Assisted Laparoscopic Revision of Previous Restrictive Operations to Vertical Banded Gastroplasty

Background: Revision of failed gastric restrictive procedures to proximal Roux-en-Y gastric bypass (RYGBP) is the standard for many bariatric surgeons. Where the patient is not a suitable candidate or simply refuses gastric bypass, an alternative is herewith proposed. Methods: 3 patients had undergone a gastric banding as the original operation and 1 patient had had a vertical banded gastroplasty (VBG). 1 patient presented with insufficient weight loss, 1 with regain of weight and 2 with complaints of food intolerance and vomiting. The gastric bands were removed by hand-assisted laparoscopy (HALS), with conversion to a VBG. In the patient with stomal stenosis after a VBG, HALS interposition of PTFE was performed to enlarge the collar. Results: In 2 patients, further weight reduction was achieved. In the other 2 patients, relief of symptoms was achieved.There were no complications during or after the revisional surgery. Conclusion: HALS conversion of a gastric banding to a VBG, or PTFE interposition in the case of stomal stenosis after a VBG, can be a valuable alternative for patients unsuitable for or refusing proximal RYGBP.